Radiation Oncology

Radiation Physics

There were four divisions of the Department of Radiology; Radiation Biology, Radiation Therapy, Nuclear Medicine, and Diagnostic Radiology.

After 24 years, Kaplan resigned as Department Chairman (1972) to devote his time to research, and to follow-up his Hodgkin's disease patients. He died in 1984 after an exceptional career.

Malcolm A. Bagshaw joined the Department in 1956, and in 1960 was appointed head of the Division of Radiation Therapy. In 1972, he succeeded Kaplan as Chairman of Radiology, and held this position until 1986, when he continued as Chairman of the new Department of Radiation Oncology until 1992.

Bagshaw, together with Kaplan, introduced a series of innovative techniques that exploited the high energy and precise beam definition of the linear accelerator in the treatment of a variety of cancers, including those of head and neck, larynx, cervix, ovary, lung, testicles, and bladder.

He refined the treatment of retinoblastoma, and systematized the electron beam therapy of mycosis fungoides, and with Zvi Fuks reported the first long-term disease-free survivals of this disease.

Bagshaw demonstrated improved local-regional control of cervical adenopathy in head and neck cancer by the effective irradiation of presumed occult lymph node metastases, an observation that was independently reported at M.D. Anderson by Gilbert Fletcher and Rodney Million.

Bagshaw demonstrated potential enduring control of bone metastases by the preemptive irradiation of vulnerable metastatic sites in breast and prostate cancer. He is also credited with developing the external beam irradiation of prostate cancer.

Treatment with interstitial radioactive sources was expanded, intraoperative radiotherapy was introduced, and a clinical investigative program in hyperthermia was started. Meanwhile, there was continued collaboration with industry to improve linear accelerator performance, and later, collaboration with Dr. John Adler, Department of Neurosurgery, in the development of stereotactic irradiation.

Early in the evolution of the radiation oncology program, and at the beginning of the computer era, a comprehensive computerized clinical data storage and retrieval system was developed by the department, which permitted the timely reporting of clinical results.

The faculty recognized the divergent missions of diagnostic and therapeutic radiology, and reorganized into two departments in 1986. The two departments were named the Department of Radiology, which included the Divisions of Diagnostic Radiology and Nuclear Medicine, and the Department of Therapeutic Radiology. The latter name was changed to Radiation Oncology within a few months, and included the Division of Radiation and Cancer Biology, and the Division of Radiation Therapy and its Section of Radiologic Physics, which became the Division of Radiation Physics in 1995.

Bagshaw retired in 1992, and Richard T. Hoppe was appointed Chairman of Radiation Oncology, and assumed the Henry S. Kaplan - Harry Lebeson Chair in Cancer Biology.

Radiation Therapy

Believing that the availability of a high-energy source could improve the effectiveness of radiation in treating deep-seated tumors, Kaplan undertook a collaborative research effort with Edward Ginzton of the Stanford Physics Department. By 1952 they had secured research funding to construct a 6 MeV electron linear accelerator suitable for radiation therapy. The Stanford medical linear accelerator was completed in 1955, and was the first linear accelerator employed routinely for radiotherapy in the Western hemisphere. Its first use was in the successful treatment of a 7-month old boy suffering from retinoblastoma.

During the 1950s and 1960s, the Division continued to develop protocols designed to improve the survival of patients with cancer. In 1961, Kaplan recruited Saul A Rosenberg, a medical oncologist, to join the Department. Rosenberg's appointment in Radiology and Medicine resulted in a successful multidisciplinary approach to the study and treatment of cancer. Kaplan, Bagshaw and Rosenberg initiated the first randomized, prospective studies on the treatment of Hodgkin's disease and other lymphomas, using high-energy radiation and statistical analysis to establish the validity of an aggressive approach to treating these diseases. Clinical trials to promote the understanding and management of Hodgkin's disease and non-Hodgkin's lymphoma were highly productive, and resulted in dramatic improvement in the cure rate of these diseases. Later studies evaluated the effects of radiation sensitizers, negative pi mesons, and hyperthermia in treating malignant tumors.

Over the years, the faculty has trained one of the largest group of residents and fellows in radiation oncology in the USA.

  • Richard T. Hoppe, M.D., F.A.C.R. He joined the Department in 1976, and now serves as The Henry S. Kaplan - Harry Lebeson Professor and Chairman of Radiation Oncology. His areas of interest include: Hodgkin's disease, non-Hodgkin's lymphoma, mycosis fungoides, radioimmunosuppression (total lymphoid irradiation), total body irradiation, and bone marrow transplantation.
  • Malcolm A. Bagshaw, M.D., F.A.C.R. He joined the Department in 1956 and held the Henry S. Kaplan - Harry Lebeson Chair in Cancer Biology. He was Department Chairman from 1972 to 1992. He became Professor Emeritus in 1992. His major area of interest is prostate cancer.
  • Sarah S. Donaldson, M.D., F.A.C.R. She joined the Department in 1969, and now serves as the Catharine and Howard Avery Professor. Her areas of interest include: pediatrics, eye and orbit, soft tissue and bone sarcomas, Hodgkin's disease and Non-Hodgkin's Lymphoma, central nervous system tumors, skin cancer, breast cancer, radiotherapy for benign disease, and the late effects of cancer and its treatment.
  • Don R. Goffinet, M.D., F.A.C.R. He joined the Department in 1972, and now serves as Professor. His areas of interest include: head & neck, interstitial, bladder, prostate, breast, IORT, stereotactic, pituitary (& brain), osteos & other sarcomas, and clinical hyperthermia.
  • Daniel S. Kapp, Ph.D., M.D. He joined the Department in 1984, and now serves as Professor. His areas of interest include: gynecological malignancies, melanoma, anal cancers, rectal cancers, hyperthermia mechanisms & clinical applications, Hodgkin's disease, and sarcomas.
  • Steven L. Hancock, M.D. He joined the Department in 1985, and now serves as Associate Professor. His areas of interest include: prostate, esophagus, stereotactic, Hodgkin's disease & non-hodgkin's lymphomas, late effects of radiation, radiation injury, radiation sensitizers.
  • Susan J. Knox, Ph.D., M.D. She joined the Department in 1990, and now serves as Associate Professor. Her areas of interest include: radioimmunotherapy, low dose rate effects, radioprotective agents, growth factors/receptors, oncogenes (bc1-2), apoptosis & radiosensitivity, apoptosis and signal transduction pathways, effects of radiation on immune response, biological response modifiers, non-Hodgkin's lymphoma, and mycosis fungoides.
  • Melanie C. Smitt, M.D. She joined the Department in 1991, and now serves as Assistant Professor. Her areas of interest include: breast cancer, head and neck cancer, and 3-D treatment planning.
  • Henry S. Kaplan, M.D., F.A.C.R. He joined the Department in 1948 as Professor and Chairman. He held the Maureen Lyles D'Ambrogio Chair. He stepped down as Department Chairman in 1972. His major clinical interests were the development of innovative radiation therapy machines, e.g., linear accelerator and pi meson generator, and the radiation therapy of Hodgkin's Disease and non-Hodgkin's lymphoma. In the laboratory, he worked on the viral and radiatlion etiology of lymphomas, and related areas of cell biology. He passed away in 1984.

Radiation and Cancer Biology

Kaplan was well under way with his research on lymphomagenesis when he came to Stanford in 1948, and he brought with him, from the laboratory of L.C. Strong at Yale University, the unique strain of mice that he had shown was susceptible to radiation-induced lymphoma. He soon obtained a research grant, and began recruiting a full-time laboratory staff. In 1956, he recruited Kendric C. Smith to pursue research in radiation biochemistry, and he recruited Robert F. Kallman to serve as head of a new Division of Radiobiological Research.

Ultimately, the Division had sufficient resources to support a full-time Ph.D. faculty (see below), a wide-ranging research program in tumor cell radiobiology, radiation biochemistry and photobiology, and cellular physiology. The Division was fully integrated with the clinical training of young radiation oncologists at Stanford. In 1975, the Louis B. Mayer Cancer Biology Research Laboratory was dedicated, with Kaplan as its head. The separate building was designed for the safe handling of viruses being studied for their relationship to human cancers. In 1984, Kallman stepped down as Division Director, and his position was taken by J. Martin Brown.

  • J. Martin Brown, D.Phil. He joined the department in 1968, and became Professor and Division Director in 1984 - 2005. His research is focused on understanding the mechanisms responsible for the resistance of solid tumors to various cancer therapies, and to developing strategies to overcome these resistances.
  • George M. Hahn, Ph.D. He joined the department in 1963, and became Professor Emeritus in 1993. His research focused on the effects of hyperthermia on normal and neoplastic cells, with and without additional treatment with radiation or drugs.
  • Robert F. Kallman, Ph.D. He joined the department in 1956, and became Professor Emeritus in 1992. He was Division Director from 1956 to 1984. His research focused on tumor cell radiobiology, and laboratory models for the radiation therapy of tumors.
  • Kendric C. Smith, Ph.D. He joined the department in 1956, and became Professor Emeritus in 1992. His research focused on the photochemistry and radiation chemistry of DNA, the genetic control and biochemical basis of the multiple pathways of DNA repair, and the role of DNA repair processes in radiation-induced and spontaneous mutagenesis.
  • Amato J. Giaccia, Ph.D. He joined the department in 1989, and is now Professor and Director of the Division of Radiation and Cancer Biology. He holds the Jack, Lulu and Sam Willson Professorship in Cancer Biology. His research is focused on the signaling pathways that trigger the induction of mammalian stress response genes (S0S genes), such as the p53 tumor suppressor gene, and how alterations in the expression of these genes can affect malignant progression.

Radiation Physics

The development of the electron linear accelerator in 1956, and the realization that its capabilities required continuing interaction with physicists, a Section of Radiologic Physics was established in the Department in 1958, with Mitchell Weissbluth as head. With the move to the campus in 1959, Weisbluth transferred his activities to the Department of Applied Physics, and C. J. Karzmark became head. During the next 30 years until his retirement in 1988, Karzmark and the physics group developed treatment techniques basic to the evolution of modern radiotherapy using linear accelerators, and pioneered relevant quality assurance concepts.

Peter Fessenden became Section Chief in 1980. The group then focused on the use of heavy charged particles (pions), and hyperthermia in treating malignant tumors, as well as developing improved total body radiotherapy techniques, and conventional and frameless stereotactic radiosurgery/radiotherapy. Fessenden retired in 1995.

In 1995, the Section of Radiologic Physics was elevated to the Division of Radiation Physics, and Arthur L. Boyer was recruited as Professor and Director.

  • Arthur L. Boyer, Ph.D. He joined the Department in 1995, and serves as Professor of Radiation Oncology, and Director of Radiation Physics. His research is focused on radiation transport, three-dimensional conformal therapy, patient position verification, and X-ray beam intensity modulation.
  • Peter Fessenden, Ph.D. He joined the Department in 1972, became Professor Emeritus in 1993, and was called back to Active Duty from 1993-1995. He served as Acting Section Chief from 1980-1982, and Section Chief from 1982-1995. His reaserch interests included: heavy particle radiotherapy, precision radiotherapy, and hyperthermia.
  • Clarence J. Karzmark, Ph.D. He joined the Department in 1954, and became Professor Emeritus in 1988. He served as Section Chief from 1959-1980. His research interests included radiation measurement, radiation treatment technique development, treatment simulation, and linear accelerator safety.
  • Lei Xing, Ph.D. He joined the Department in 1996, and serves as Assistant Professor. His research is focused on intensity modulated radiation therapy (IMRT) as well as development of alternate imaging modalities.

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